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Abstract Number: 2381

Adherence to a Treat-to-Target (T2T) Strategy in Early Rheumatoid Arthritis. Is It Feasible in Daily Clinical Practice?

Christian A. Waimann1, Gustavo Citera2, Fernando Dal Pra3, Maria Celeste Orozco4, Federico Ceccatto5, Sergio Paira6, M Gauna7, Anastasia Secco7, M Mamani7, Lucila Marino8, Francisco Caeiro9, AC Alvarez10, Maria Haye Salinas9, L Encinas11, Javier Rosa12, Valeria Scaglioni13, Enrique R. Soriano14, Josefina Marcos15, Mercedes García15, A Salas15, Alejandro Martinez16, Rafael Chaparro del Moral17, Oscar Luis Rillo17, Horacio Berman18, Alberto Berman18, Francisco Colombres18, Edson Veloso19, Ricardo V. Juárez20, Maria Elena Crespo21, Ana Quinteros22, M Leal22, Gabriela Salvatierra23, C Ledesma23, Mónica P. Sacnun24, R Quintana25 and Marcelo Abdala26, 1Rheumatology, Hospital Olavarria, Olavarria, Argentina, 2Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 3Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina, 4Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 5Rheumatology, Hospital Jose María Cullen, Santa Fé, Argentina, 6Section of Rheumatology, Hospital Jose Maria Cullen, Santa Fe, Argentina, 7Rheumatology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina, 8Rheumathology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina, 9Reumatología, Hospital Privado de Córdoba, Córdoba, Argentina, 10Hospital Privado Centro Médico de, Córdoba, Argentina, 11Rheumatology, Hospital Privado Centro Medico De Córdoba, Cordoba, Argentina, 12Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 13Rheumatology Unit, Internal Medical Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, 14Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, 15HIGA San Martín, La Plata, Argentina, 16Rheumatology Unit, Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina, 17Rheumatology Section, Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina, 18Centro Medico Privado de Reumatologia, Tucumán, Argentina, 19Sanatorio y Universidad Adventista Del Plata, Entre Rios, Argentina, 20Rheumatology Section, Hospital Señor del Milagro, Salta, Argentina, 21Hospital Señor Del Milagro, Salta, Argentina, 22Centro Integral de Reumatología, Tucumán, Argentina, 23Instituto Provincial De Rehabilitación Integral, Stgo. del Estero, Argentina, 24Hospital Provincial, Rosario, Argentina, 25Hospital provincial, Rosario, Argentina, 26Hospital Provincial del Centenario, Santa Fe, Argentina

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: clinical practice and treatment, Early Rheumatoid Arthritis

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Impact of Various Interventions and Therapeutic Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose :  The treat-to-target (T2T) strategy has become the new paradigm for the treatment of Rheumatoid Arthritis (RA); however the question is whether this strategy is feasible in daily clinical practice. The purpose of the study was to evaluate the adherence to a T2T strategy aiming at remission in a cohort of DMARD naïve patients with early RA.

 Methods : We included DMARDs naïve patients with diagnosis of early RA belonging to a prospective cohort of patients with diagnosis of early arthritis (<2 years of disease duration). Data was collected every 3 months, including sociodemographic characteristics, functional status (HAQ), disease activity (DAS28) and medication. Clinical remission was defined as DAS28 < 2.6. The primary outcome measure was the proportion of cohort visits in which therapy was adapted according to disease activity, stratified by remission state. Compliance with the T2T recommendations was defined as a change in drug treatment in patients failing to achieve clinical remission. Treatment strategies were stratified in seven groups: i) addition or dose escalation of NSAIDs, ii) addition/change of DMARDs, iii) dose escalation of DMARDs, iv) addition/change of biologic agents, v) addition or dose escalation of oral prednisone, vi) administration of parenteral corticosteroids, vii) administration of intra-articular corticosteroids. Compliance with T2T and treatment strategy was evaluated on each visit. The statistical analysis was carried out using STATA 12.

Results: We included 535 DMARDs naïve patients with early RA. Mean age was 51 ± 14 years, 82% were female and disease duration was 7 ± 6 months. The patients contributed to a total of 3022 visits (mean follow-up = 24 ± 16 months). Mean HAQ and DAS28 score during follow-up were 0.9 ± 0.6 and 3.9 ± 1.2, respectively. Patients did not achieved remission in 2063 (68%) of the visits. A change in drug treatment was registered in 42% of these visits.  The most frequent strategy was addition/change of DMARDs (31%), followed by addition/dose escalation of oral prednisone, addition/dose escalation of NSAIDs, dose escalation of DMARDs, intra-articular corticosteroids, parenteral corticosteroids and addition/change of biologic agents (9%, 9%, 8%, 3%, 3% and <1%; respectively).

Conclusion: In our cohort, including patients with early rheumatoid arthritis in “real world”, the compliance with the T2T treatment recommendations were low. A change in drug treatment was registered in less than half of the visits where patients were not in remission.


Disclosure:

C. A. Waimann,
None;

G. Citera,
None;

F. Dal Pra,
None;

M. C. Orozco,
None;

F. Ceccatto,
None;

S. Paira,
None;

M. Gauna,
None;

A. Secco,
None;

M. Mamani,
None;

L. Marino,
None;

F. Caeiro,
None;

A. Alvarez,
None;

M. Haye Salinas,
None;

L. Encinas,
None;

J. Rosa,
None;

V. Scaglioni,
None;

E. R. Soriano,
None;

J. Marcos,
None;

M. García,
None;

A. Salas,
None;

A. Martinez,
None;

R. Chaparro del Moral,
None;

O. L. Rillo,
None;

H. Berman,
None;

A. Berman,
None;

F. Colombres,
None;

E. Veloso,
None;

R. V. Juárez,
None;

M. E. Crespo,
None;

A. Quinteros,
None;

M. Leal,
None;

G. Salvatierra,
None;

C. Ledesma,
None;

M. P. Sacnun,
None;

R. Quintana,
None;

M. Abdala,
None.

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